MedicaidAdministrativeMedium impact
5160-59-02.1 - OhioRISE: first day eligibility and enrollment. (New/Final File)
Ohio Medicaid·OH · Pediatrics, Psychiatry·Enrollment
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
Ohio has implemented a new policy establishing first day eligibility and enrollment procedures for the OhioRISE program, which provides behavioral health services for youth with complex needs. This affects billing and eligibility verification for pediatric behavioral health services in Ohio.
Action Required
Ohio billing teams should review OhioRISE eligibility verification procedures to ensure proper enrollment status checking for pediatric behavioral health patients. Update eligibility verification workflows to account for first-day coverage rules when billing for youth behavioral health services under OhioRISE.